Injured in Iraq, a Soldier Hobbles Toward Recovery

ANDREW JACOBS

Sunday

Nov 25, 2007 at 4:25 AM

One soldier’s odyssey through the Pentagon bureaucracy is shared by scores of others who have sustained traumatic brain injuries.

FREDERICKSBURG, Va. — It is hard to know whether Master Sgt. Joseph Santiago was wincing from the pain creeping from the hole in his head to his atrophied legs or from the words of the politicians who were calling him a hero. After they were done commending his sacrifice on the battlefields of Iraq, he grabbed the microphone, handed his cane to his wife, and announced that he wanted to set the record straight.

“When I hear the word ‘wounded,’ I think of someone who got shot or blown up,” he said with a pasted-on smile. “I took a fall.”

An awkward hush fell over the two dozen guests who gathered recently at a suburban mall here to christen Sergeant Santiago’s new business, a Nestle Toll House Cafe. With the ribbon cut, everyone filed inside for celebratory squares of a giant chocolate-chip cookie that had been slathered with red, white and blue frosting.

The event was meant to mark the progress that Sergeant Santiago, 42, has made since he was injured in an accident in which he fell from a 25-foot-high berm separating Iraq and Kuwait four and a half years ago. But all he could talk about was the throbbing in his head, his loss of short-term memory, his inability to distinguish numbers from letters and — most of all — his unceasing frustration over being denied combat disability status by military doctors.

“I may have bumped my head, but I’m not stupid,” he said again and again, showing one symptom of his injuries: a tendency to repeat himself.

Sergeant Santiago’s odyssey through the Pentagon bureaucracy is one shared by scores of soldiers who have sustained traumatic brain injuries, whose repercussions can be hard to quantify and even harder to treat. Doctors say more than 2,000 soldiers have suffered traumatic brain injuries in Iraq and Afghanistan, though experts say as many as 150,000 troops may be grappling with the effects of head trauma.

Hurt on the first day of the American invasion of Iraq, Sergeant Santiago has been an early test case of how military officials deal with such injuries. “Going through the medical review process has been tough for Joe, but I think the Army has learned from his experience,” said his commander, Col. Mike Bechtold, who has been an advocate for the sergeant during his travails with the government-run health care system.

Sergeant Santiago’s family and friends describe his treatment as shameful. For three years, they say, doctors at Walter Reed Army Medical Center have accused him of exaggerating his symptoms; they also have suggested that his inability to function normally is the result of a pre-existing malformation at the base of his skull.

Last year, a doctor at a Veterans Affairs hospital in Washington disagreed with that assessment, saying Sergeant Santiago’s memory loss, slurred speech and nerve damage were caused by his fall. Still, without an official designation from a medical review board at Walter Reed, he is not entitled to collect the full retirement benefits awarded to injured soldiers. He has spent 25 years in the Army, and is scheduled to retire formally in three months.

His injuries are the result of a misstep in the dark. Sergeant Santiago, a chemical and biological weapons expert, was patrolling a berm on the Iraq-Kuwait border when a firefight between American and Iraqi troops broke out in the distance. He was watching through his binoculars when a comrade called out his name. Pivoting in the blackness, he misjudged the edge of the wall and plummeted head first into the sand below.

After regaining consciousness, he hauled himself up, ignoring calls to await a medic and shouting, he recalled, “I’m fine! I guess I have two left feet!”

Sergeant Santiago would gradually lose the attributes that made him a prized member of his team, which was searching for unconventional weapons. He could hide the pain and numbness in his limbs, but his fellow soldiers noticed that he was repeating himself and forgetting orders. It was during an ambush in Karbala, when Sergeant Santiago’s leaden legs would not let him flee his vehicle, that he had to admit there was something wrong.

He flew back to the United States, and a series of tests revealed jangled vertebrae, swelling in his brain and tears in the lining of his hip joint. He underwent emergency surgery — cutting out a section of his skull to relieve the pressure on his brain — but by then, the damage had been done.

He easily snapped into fits of rage, he urinated uncontrollably and he became obsessed with cleanliness. Sometimes he forgot he had taken his medication moments earlier and would take a second dose. He spent days in pain, curled up in a fetal position. Any noise worsened his agony, so he avoided his family.

“I became pretty intolerable,” he said. His wife, Stacy, said she flirted with divorce, but since last year, when he had a device implanted in his brain to help neutralize the pain, Sergeant Santiago has become more even keeled.

“I feel like I married two different men,” said Ms. Santiago, 37, taking a break from her baking duties at the cookie store. “Joe before the war and Joe after the war.”

Sergeant Santiago, who spent much of his enlisted life based at Fort Drum in Watertown, N.Y., and — in addition to Iraq — served in Afghanistan, Bosnia and Germany, said that he would prefer to stay in the Army, but he has been told by officials that that will not be possible.

Facing life in the civilian world, he decided that starting his own business with his wife might be the only way to support his family. But then he encountered another round of problems. He spent his family’s savings to buy the Nestle franchise and applied for a business loan to pay for construction of the store. More than a year later, with renovations on the store under way, his loan application was rejected, he said, because bank officers were worried that his disability made him a credit risk.

The Santiagos found the Veterans Corporation, a nonprofit group that helps veterans start businesses. James Mingey, an advocate and disabled Vietnam War veteran, took up his case and convinced the bank that denying the loan would be create more trouble than it was worth.

The cafe’s christening two weeks ago was a bittersweet affair. Men in military fatigues streamed in to show their support while Sergeant Santiago talked about the impending round of surgeries he faced and his hope of somehow staying in the military.

As he spoke, his leg bounced like a piston and his face was contorted, a response, his wife explained, to the mounting pain. “By 7 o’clock,” she said. “I’ll have to take him home, and he’ll be curled up in a ball.”

When he went outside to smoke a cigarette — he burns through a pack a day — Ms. Santiago sat down for a break. The business is officially his, she said, but she does the work since her husband spends most of his days going to physical therapy sessions or doctor’s appointments.

“Sometimes I want to kill him, but we’ve all learned to have patience,” she said wearily. “The only good thing is that we fight, and 10 minutes later he forgets it ever happened.”

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